Environmental defenders: public health champions
Authors: Liz Willetts
Journal: The Lancet Planetary Health (2022)

The health sector carries the burden of environmental disease but has few levers to address its root cause. Worldwide, activists known as environmental defenders serve this role. Environmental degradation is common in all regions of the world. Some communities live with seasonally hazardous air conditions, pesticide-contaminated water, polluted breast milk, or simply, no green or blue space or view of other living species. Such conditions are not normal or healthy, but individuals who protest these conditions are framed as social outliers, too often paying for their outspokenness with their lives. As a society, our environmental footprint is already exceeding several planetary boundaries, and continues to grow; as does the pool and diversity of individuals attempting to safeguard our natural environments for the future. When the health of whole communities is threatened, the health sector needs to do more than monitor and treat individuals. The health community needs to backbone the environmental defence movement and find its voice in this work. Tim Takaro started his career investigating exposure of workers to asbestos, a building contaminant that damages the lungs and causes cancer. This link led Takaro to look at gene–environment interactions of lung disease, such as those that lead to childhood asthma, which is how he became involved in analysing the burning of fossil fuels, and the air pollutants that cause climate change. After a lifetime of producing data, now at the peak of his profession, Takaro's view on environmental policy is: “evidence is not enough.” Phyllis Omido, who campaigned to highlight heavy metal contamination across Kenya, had the same issue. “I thought it would be easy—it was an open and shut case,” she said, referring to the blood concentration of lead in one member of her community in Owinouhuru that was 100 times (430 μg/dL) the safe level. But years passed before the community and Kenyan Government took action to respond to her information. Many health institutions recognise the health impacts of polluted air, water, and contaminated soil, and use public health strategies that are aimed at avoiding and monitoring harmful exposure. However, in most countries, health plans and health sector mandates do not extend to addressing the drivers and root cause of environmentally associated poor health outcomes. When medical professionals are disconnected from the state of the local environment it leaves a big gap in public health. Omido's 2-year-old son was symptomatic across four organ systems for 5 months, including a month of hospitalisation, before a diagnosis of lead toxicity was made. Clinicians in the area were not aware of or trained to consider pollutant exposure as a diagnosis. Despite having 18 battery recycling factories in Kenya, where batteries and their parts were carried, broken, sorted, washed, and inserted into a furnace by hand, the national health system did not have any appropriate tests or laboratory processing facilities for lead exposure. Eventually, Omido sent her son's blood sample to a laboratory in South Africa for analysis. The UN Environment Programme defines environmental defender as “individuals and groups who, in their personal or professional capacity and in a peaceful manner, strive to protect and promote human rights relating to the environment.” Environmental defenders, who spearhead grassroots advocacy to protect the environment, are typically framed as social outliers, and outcasts, sometimes with fatal consequences. More than 50 countries have reported deaths of defenders in the past two decades. Worldwide in 2020, more than 220 defenders were reported to have been killed and hundreds more non-lethal attacks were recorded. Most defenders have traditional roles in society and economies, and many hold jobs closely tied to the land, such as in small-holder farming or park ranger roles. Many identify with Indigenous communities, and many defenders live in the global South. Being labelled an environmental defender, or activist, often changes a person's status in a negative way. Despite Takaro's career linking environmental degradation and public health, we would not typically consider him, a physician and toxicologist, to be an environmental defender. At least not until he was arrested earlier in 2022 and jailed for a month for camping in a tree to protest the expansion of crude oil processing in Canada under the Trans Mountain Expansion Project. The Expansion Project carries with it many local and global health risks, from ecological disruption caused by deforestation and trenching salmon streams, to enabling large-scale burning of fossil fuels, among other harms. When Takaro talks about his connection with the environment, he describes experiences that are strikingly traditional for a North American. He mentions a childhood in the hills of western North Carolina, lessons from his Boy Scout troupe, and early exposure to social concerns from attending his Unitarian Universalist church. The tree in which he protested the oil pipeline is part of a trail he had been hiking regularly for 17 years. Omido had a university business degree and her position in the smelting company opened many doors to communicate with business and political leaders. She was not labelled an activist until she spoke to workers about how exposure to toxic lead dust from the workplace led to the hospitalisation of her young son. “It was terrible,” said Omido, who reports she was bundled onto the bed of a truck, put on the news, and publicly described by the police to be a criminal. “No one would employ me”, she said. Environmental defence is a leadership role that needs to be celebrated and rewarded. The narrative that environmental defenders protect land is too simple. They defend essential elements for our wellbeing—the environmental determinants of human health—including water, air, soil, food, and the ability to access nature for our mental health. The value of a healthy environment is extensive, but our society has trouble communicating that. We do not adequately recognise, account, or express, in words, numbers, or ideas, that we as a society are operating on, and contributing to, a net nature loss on a daily basis. “[Society has] a little bit of a problem looking ahead seven generations like Indigenous Peoples do and we are mortgaging that future”, said Takaro. “It is extremely grave, and it is not our right to do it.” The precautionary principle states that in situations where there is potentially serious risk of harm, absence of scientific certainty should not inhibit measures to prevent environmental degradation. This principle surfaces regularly in environmental decision making debates. But the opportunity to decide how environmental determinants of health are valued is not up to individuals. Omido points to a lack of transparency, “The people of Owinouhuru were not equipped to make a decision when [the] opportunity for smelting jobs was proposed. Someone should have warned us about the risks of contamination when they advertised these livelihoods, so we had information to allow us to decide.” Environmental defenders often take this much needed role of sentinel. Environmental defenders have long demanded the right for nature to be a priority. Adoption by the UN General Assembly of the human right to a clean, healthy, sustainable environment in July, 2022, was an international law milestone, giving stakeholders the right to demand these conditions. The health community must be part of this conceptual shift. It must mobilise knowledge on environmental drivers of disease and on the health value of the environment, and use a rights-based approach to amplify the work of environmental defenders. The health-sector should become equipped with an understanding of human rights tools. “Public health requires a degree of advocacy,” said Takaro. “Getting clinical students into policy internships would be excellent training for them to understand gaps in using the evidence base.” Health community partnerships with civil society and local communities on environmental issues is a priority, according to Omido. She draws attention to how the Environmental Impact Assessment (a legal tool employed worldwide prior to a project to consider and, ideally, avoid, environmental harms) for the Kenya smelter industry did not thwart business, because the project was approved by six government ministries, including the Ministry of Health. Rallying around the implementation of global environmental agreements is another way to support environmental defenders and the human right to a clean, healthy, sustainable environment. When public health professionals engage in these processes it elevates environmental degradation as a public health concern. Takaro's efforts, for example, support Canada's implementation of the UN Framework Convention on Climate Change. Omido's campaign supports Kenya's implementation of the Basel Convention on Transboundary Movement of Hazardous Waste. “It's not science, it's ethics,” said Tim. “We need more moral fibre. 2000 years ago our ancestors were doing planetary health; we need to relearn planetary health.” Environmental defenders’ stories can inspire and guide the health community to develop a cohesive, impactful voice for safeguarding the environment. Indigenous communities, such as the First Nations peoples in Canada, the Xingu in Brazil, the Kalikasan in the Philippines, the Maya in Guatemala, and the Shuar in Ecuador, work to highlight important environmental issues that need more attention. At the international level, a crowning example from an Indigenous group is the central role of the Inuit Circumpolar Council in the establishment of the Stockholm Convention on Persistent Organic Pollutants, which is an international environmental treaty aimed at curbing use of and exposure to toxic chemicals. Omido's 13 years of environmental advocacy changed three sectors in Kenya. Firstly, it led to the closing of 17 smelting companies in Kenya and influenced regional export policies around importing recycled lead from East Africa. Secondly, her campaigns protected the health of people and ecosystems, including child development and growth, soil and water quality, and fish stocks and livestock. Thirdly, her work revolutionised the national health system, which now has clinical laboratories capable of lead testing and periodic monitoring programmes for lead. Environmental defenders are public health champions who have local, national, regional, and global impacts. Health experts can do more to champion environmental defenders and accelerate environmental efforts worldwide.